Child Health Policy and Strategy 2012 – 2015

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Child Health Policy and Strategy

Child Health Policy and Strategy2010 - 2015

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Acknowlegements

Child health in Fiji has for many years been a priority of both the Public Health Division and Paediatric Department. For decades these two departments have worked in synergy ensuring the health and wellbeing of all children. This synergy is evidenced by the early introduction of new and underutilised vaccines, Integrated Management of Childhood Illness, Prevention of Parent to Child Transmission (PPTCT) as well as adoption and support to breastfeeding and Infant and Young Child Feeding just to name a few.

Over the years the Paediatric and Public Health Departments have worked towards improving Child Health through their core function at the Colonial War Memorial Hospital (CWMH) and other divisional hospitals, while supporting and promoting all other activities outside of the hospital. This is reflected in the paediatric department’s goal;

“to provide the services required to meet child health needs to improve and promote the health and welfare of children, through provision of the necessary specific and specialized care and provision and promotion of the preventive aspects of that care, so that the children may reach adulthood in optimum health able to compete at the maximum level of their capabilities.”

The Child health Policy and Strategy development followed a comprehensive Child Health Review that identified priority areas that will lead to improvements in child health outcomes and Fiji’s ability to meet MDG targets. This innovative Policy has a Strategic Focus and Annual work plans. It has captured the indicators for which divisions could work to in an orchestrated way to meet national targets.

The development of this Child Health Policy and Strategy involved the consultations of many stakeholders involved in the care of infants and children in Fiji. The development of this policy document would not have been possible without the support of Dr Fiona Russell who developed the first draft of the policy before it was edited by the Paediatric (Headed by Dr Joseph Kado) and Obstetrics & Gynaecological (Headed by Dr James Fong) CSN with the support and help of Dr Frances Bingwor (National Advisor Family Health) and Kylie Jenkins (Technical Facilitator Infant & Child Health, FHSSP) & Dr Rosalina Sa’aga-Banuve, (Program Director, FHSSP).

The Ministry of Health would like to acknowledge AusAID and FHSSP for the funding support towards the development of this important document

…………………………………..Ms Una Bera(Acting Deputy Secretary Public Health)

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Table of Content

1. Introduction 7

1.1 Purpose of the Policy Document 7

1.2 Background 7Figure 1: Child mortality statistics, 2000-2009 8 ▪Figure 2: Contribution of each age group to all U5 year old deaths, 2008 9 ▪Table 1: Fiji’s progress on core indicators to monitor child survival 10 ▪

1.3 Organisation of Child Health Services 12

1.4 Challenges and the Role of Policy Direction and Support 13Provision of Adequate Resources. 14 ▪Establishment of Effective Management, Coordination and Supervisory ▪

Systems 14

1.5 Structure of the Policy Document 15

2. Policy Statement for Infant and Child Health 16

2.1 Vision, Mission and Goal 16

2.2 Policy Statement 16

2.3 Key Policy Areas on Infant and Child Health 17Activities Under Strategic Area 1: Neonatal Services 17 ▪Activities Under Strategic Area 2: Clinical Paediatric Services 18 ▪Activities Under Strategic Area 3: Preventive Paediatric Service Through EPI, ▪

HIV-PPTCT, RHD Programmes 19Activities Under Strategic Area 4: Integrated Management Of Childhood ▪

llnesses 19Activities Under Strategic Area 5: Infant Feeding And Nutrition, And ▪

Breastfeeding 19Activities Under Strategic Area 6: On-going Development And Support For ▪

Operational Research 20Cross-Cutting Issues 20 ▪Performance Indicators 21 ▪

3. NATIONAL CHILD HEALTH WORK PLAN 22

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Chapter 1: Introduction

1.1 Purpose of the Policy Document

The purpose of this Policy & Strategy document is to outline policy statements of the Ministry of Health in support of Infant and Child Health. It outlines a framework of key strategic areas and activities to be implemented and identifies mechanisms for improving the effectiveness and efficiency of programmes and services. The policy document represents national commitments to support child health care at the highest level and calls for responsive action at all levels of the health care delivery.

The development of the Child Health Policy provides an opportunity to redefine common vision and mission, revisit goals and objectives, identify programme priorities, assess emerging issues, reprioritise areas for action; and to establish a roadmap for strengthening the delivery of a results-based programme. The policy reaffirms the need for adequate resources in order to implement an effective programme and deliver quality services. It also emphasizes the importance of strengthening the management and coordinating mechanisms to facilitate the achievement of both curative and preventive aspects of child health as reflected in the vision and mission of the programme.

1.2 Background

The Republic of Fiji Islands lies within the Pacific Ocean and is currently classified as a lower-middle income country. Fiji’s population of 827,900 primarily consists of I Taukei (57%), who are predominantly Melanesian, and Indo-Fijians (38%). Over 75% of the population live on the island of Viti Levu. There has been rapid urbanisation of the Suva peri-urban area, particularly in the area of Nasinu, in the Suva-Nausori corridor. Meanwhile the Northern Division has experienced a very substantial population decrease.

Fiji is party to the Millennium Declaration of 2000 and is committed to achieving the Millennium Development Goals (MDG) targets by the year 2015. The country has incorporated the MDGs in the Strategic Development Plan (SDP) 2011-2015, to ensure that national policies are consistent with the MDGs. The government of Fiji is committed to achieving the child health related MDG targets (MDG 1, 4, and 5) and acknowledges the contribution of reproductive health programme in the achievement of MDGs, in particular the health-related MDGs (MDG 4, 5, 6).

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1 Child healthcare review. Fiji Health Sector Improvement Program, Ministry of Health, 2010. 2 Vital and Health Statistics, MoH.

Figure 1: Child mortality statistics, 2000-20092

0

5

10

15

20

25

30

1990 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

U5MR

IMR

Perinatal mortality

Early neonatal mortality

Neonatal mortality

Post-neonatal mortality

2015 U5MR target

2015 IMR target

In August 2010 the Ministry of Health undertook a Child Healthcare Review with the aim of evaluating how child health services can make an impact on improving Fiji’s MDGs related to child health1. The review was based on an analysis of the progress in meeting MDG 4 targets including clinical services for child healthcare, the Integrated Management of Childhood Illness (IMCI), the Expanded Programme of Immunisation (EPI), the Baby Friendly Hospital Initiative (BFHI), child nutrition, health information, research and surveillance, and monitoring and evaluation.

The findings of the review showed that there has been little change in the infant mortality rate (IMR) and under 5 mortality rate (U5MR) for the past 10 years (Figure 1)1. The commonest reasons of morbidity and mortality in infants of birthweight >2500g and gestational age ≥34 weeks were perinatal asphyxia, meconium aspiration, and neonatal sepsis. These infants were more frequently admitted to the neonatal intensive care unit (NICU) at CWMH than those that were of low birthweight (<2500g) or <34 weeks gestation.

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Figure 2: Contribution of each age group to all U5 year old deaths, 2008

Stillbirths

0-<7d

7d-<28d

28d-<1y

2y

3y

4y

28%

11%

29%

7%

4%

17%

4%

Common reasons for admission and mortality in the infants of low birthweight and gestational age <34 weeks were hyaline membrane disease (immature lung), neonatal asphyxia, meconium aspiration syndrome, and neonatal sepsis. Acceleration of MDG4 progress could be made if more attention is given to improving the quality of antenatal and perinatal services as the currently under resourced Obstetric and Antenatal services are significant contributors.

In addition, a sizeable proportion (44%) of all under 5 year old deaths occurred after the neonatal period (Figure 2)1. A number of factors including delayed health seeking behaviour due to lack of recognition of illness severity and transportation issues, and delayed referral from subdivisional hospitals were the most frequent factors associated with childhood deaths1. The commonest reasons for admission to hospital for children beyond the neonatal period include pneumonia, sepsis (from infected scabies, impetigo, meningitis, pneumococcus, and unknown aetiology), abscess and cellulitis, acute gastroenteritis (with 29% due to rotavirus), congenital heart disease, and injuries. Early detection and treatment of pneumonia and diarrhoea (case management by IMCI trained nurses), in many cases, may prevent the progression to severe disease and hospitalisation. However IMCI is not operational in many of the divisions and shortages of IMCI drugs are common. Severe heart damage from rheumatic heart disease (RHD) following acute rheumatic fever is common and potentially preventable by early detection and good compliance with secondary penicillin prophylaxis.

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To achieve MDG 4 targets, attention to the continuum of care is paramount. Establishment, promotion of and support for the healthy child is everybody’s business. Primary health care is equally as important as curative care. More than 80% of all childhood deaths occur in the three divisional hospitals. Good quality hospital care for children is required to increase the impact of appropriate primary health care interventions on child survival and contribute to achieving MDG 4. Clinical Practice Guidelines (CPGs) are being developed to improve the quality of services delivered.

NA: not available

Components of essential package

Core indicators Percentage (%)

Skilled attendance during pregnancy, delivery, and immediate postpartum

Proportion of births assisted by health personnel 98.8% (2008)3

99.8% (2009)

Care of the newborn Proportion of infants <12 months of age with breastfeeding initiated within one hour of birth

>99%4

Breastfeeding and complementary feeding

Proportion of infants <6 months of age exclusively breastfed

40-50%5

Proportion of infants 6-9 months of age receiving breastmilk and complementary food

NA

Micronutrient supplementation Proportion of children 6-59 months old who have received vitamin A in the past 6 months

Not done

Immunisation of children and mothers against measles

Proportion of one-year-old children immunised 93.9% (2009)6

Proportion of one-year-old children protected against neonatal tetanus through immunisation of their mothers

33%6

Integrated management of sick children

Proportion of children 0-59 months of age who had diarrhoea in the past 2 weeks and were treated with oral rehydration solution

NA

Proportion of children 0-59 months of age who had suspected pneumonia in the past 2 weeks and were taken to an appropriate health care provider

NA

Table 1: Fiji’s progress on core indicators to monitor child survival

3 Ministry of Health draft Annual Report 2009.4 PATIS Ministry of Health, average for years 2007-2009.5 The official rate of 85.5% in the National Dietetic returns, Ministry of Health, 2009, is likely to reflect a substantial degree of

double counting.6 EPI coverage survey, 2008/9.

Many factors contributing to childhood morbidity and mortality need continued programme strengthening. Fiji’s progress on core indicators to monitor child survival can be seen in Table 11.

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Maternity Services in Fiji are fairly well developed. While antenatal care coverage has reached more than 95% and many pregnant women receive more than four visits per pregnancy, ensuring better quality antenatal care in terms of early booking (less than 10% of women booking in the first trimester) and more goal oriented antenatal care remains a priority. Most women (>98%) give birth in the three divisional hospitals. However these hospitals are under resourced to provide services for the number of deliveries undertaken. These factors substantially contribute to the perinatal and neonatal mortality rates. Causes of death for many of the stillbirths and neonates appeared potentially preventable.

Breastfeeding rates are low at six months of age despite relatively high levels of early initiation of breastfeeding. Legislation exists to regulate the marketing of infant formulae, all hospitals have been certified Baby Friendly, but few community and workplace supports for breastfeeding are available.

A healthy diet is fundamental in keeping children healthy. There is no data on the rate of complementary food introduction but undernutrition is ~14% in children aged less than five years7. Micronutrient deficiencies are common, particularly iron, followed by Vitamin A and zinc. Despite a five year micronutrient supplementation project having commenced the importance of childhood nutrition through a healthy diet, has a relatively low profile. There is a comprehensive Food and Nutrition Policy (2008), and in 2010 the Fiji National Plan of Action on Nutrition (FPAN) was launched. The nutritional aspects of maternal and child health should be integrated into all aspects of training and service provision.

There have been many activities to increase capacity in EPI and therefore increase EPI coverage rates. The coverage rates have improved although in 2009 measles vaccine coverage rates appear to be below target which is thought to be due to a loss in experienced staff following the mandatory retirement of many health workers. The target year for measles elimination is 2012. However, ongoing support is required to achieve this and get MR vaccine coverage rates >95%. The EPI policy has recently been reviewed in 2010. The potential incorporation of new vaccines, pneumococcal conjugate vaccine (to prevent pneumococcal meningitis and pneumonia) and rotavirus vaccine (to prevent one of the commonest causes of childhood diarrhoea) into the EPI schedule requires support and evaluation. Careful planning is required to ensure there is on-going surveillance to detect non-vaccine serotypes. In addition, ongoing support is required to incorporate the planned introduction of Human papillomavirus (HPV) vaccine into the school immunisation schedule.

Primary health care is a key component in the prevention of the many of the childhood illnesses. This includes ongoing support for breastfeeding, nutritional advice, hand washing with soap, minimising the inhalation of indoor air pollution (via cooking smoke or

7 Consolidated Monthly Returns, 2005-8.

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cigarettes), oral health, making a child’s home safe, and basic parenting/child care skills. Basic first aid and CPR is also important. In addition the encouragement of food gardens and healthy eating patterns, attendance at antenatal clinic (ANC) and Maternal and Child Health (MCH) clinics, and the ability to identify a sick child needing medical care cannot be overemphasised.

To maximise a child’s potential, children need to grow up in a home and community environment that are free from violence, abuse, exploitation and neglect. Fiji ratified the Convention on the Rights of the Child in 1993 and the Child Welfare Decree (which focuses mainly on child abuse, exploitation and neglect) was instituted. When children are abused or neglected there should be guidelines in place to minimise the social, emotional and psychological implications and effects on the child.

Children with disabilities and their families often experience barriers to the enjoyment of their basic human rights and to their inclusion in society. Their abilities are often overlooked, their capacities are underestimated and their needs are given low priority. Early intervention services are required to enhance the child’s development, to provide support, assist families, and maximise the child’s benefit to society. As neonatal services improve and given that most neonates survive perinatal asphyxia, the need for early intervention and disability services may grow.

Each contact with the health system should be used as an opportunity for health promotion. MCH clinic attendance is an ideal opportunity to give vital health messages as women bring their infants to MCH at least four times in the first year of life.

Collection and collation of data is important for strategic health service delivery and planning. The Public Health Information System (PHIS) and the Patient Information System (PATIS) collect data required for planning. At all levels of the health system, planned activities should be strategic and responsive to the common childhood problems.

1.3 Organisation of Child Health Services

Different levels in the health system are defined in the Clinical Services Planning (CSP) Framework. Basic health care is provided through a hierarchy of VHW (although not formally a MoH service), nursing stations, health centres, subdivisional hospitals, and divisional and specialist hospitals. Divisional hospitals provide tertiary care and subdivisional hospitals provide primary health care and limited secondary health care services. This model has served the country well, but over recent years demographic and social change and improved transport, have meant that the location and size of the buildings require review.

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Fiji has a well developed health care system and infrastructure. Newborn and paediatric care have a well-defined clinical/curative component and a public health/preventive component. Linkages and integration between these sections are clearly supported by the Ministry. Health services and programmes are delivered through a decentralised approach through four health divisions Central, Eastern, Northern and Western Divisions.

The types of health facilities comprise the following:

Divisional Hospitals - 3 +

Subdivisional Hospitals - 17 (level 1: 4; level 2: 13) +

Health Centres - 78 +

Nursing Stations - 103 + In addition, paediatric services are also provided by the private sector comprising Suva Private Hospital and about 75 registered General Practitioners.

The MoH child health services cover a wide area of health care, with the main ones including:

1. Clinical services for neonatal and child health 2. IMCI3. MCH checks including EPI4. BFHI5. Child nutrition including Infant and Young Child Feeding (IYCF)6 School health7. RHD control8. Adolescent health care9. HIV-Prevention of Parent to Child Transmission ( PPTCT)

1.4 Challenges and the Role of Policy Direction and Support

The move towards decentralisation of programmes and services under the recent health reform aims to build infrastructure, capacity and resources at subdivisional level to be able to deliver a wide spectrum of services as adequately as possible within the constraints of available resources. However these resources have been stretched which often compromises the quality of health services provided. The health sector reforms including the 2009 mandatory retirement of officers reaching the age of 55 years had left a huge gap in senior and middle management 8.

8 MoH draft Annual Report, 2009.

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Despite the good intentions of decentralisation, Fiji continues to face significant challenges and constraints that impede the delivery of quality child health services at all levels of the health care system. These are largely related to staffing shortage, inadequately equipped facilities, weak health systems, and inadequate coordination and management of programmes and services. There have been some research activities assisting in providing an evidence-base to programming which assists in informed policy formulation. The recent Child Healthcare Review1 assisted in identifying priority areas for programming. This policy document calls for action to address these challenges and constraints. Two main action areas for policy direction to support the implementation and delivery of child health programmes and services are highlighted:

1. PROVISION OF ADEQUATE RESOURCES In order that resources are adequately mapped out to facilitate delivery of quality services, the following statements apply:

The functions of each category of health facility and services to be provided at each +

level of facility are clearly defined and communicated.The roles of staff assigned to work the facilities are clearly defined and that staff are +

adequately skilled to deliver these functions and roles.The facilities are adequately equipped with supplies, medicines, commodities and +

equipment to be able to deliver the functions prescribed for each facility.Mechanisms for ongoing capacity building, continuing education and supportive +

supervision are established and strengthened to maintain staff morale, upkeep knowledge and skills, and help retain staff.

2. ESTABLISHMENT OF EFFECTIVE MANAGEMENT, COORDINATION AND SUPERVISORY SYSTEMSIn order to support the functions of each health facility (hospital level to a nursing station), the following need to be established and strengthened:

Clearly defined management, coordination and supervisory roles effectively +

communicated to relevant staff and the health facility team. Staff in position of management and supervision are capable of and accountable +

for the effective delivery of facility functions.Clearly defined communication lines are in place to enhance coordination. +

Established patient referral system and continuity of care from one facility to +

another, and between curative services and preventive/public health services. Mechanisms for ongoing reviews & monitoring and management meetings are in +

place to support effective programme coordination and health care delivery.

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1.5 Structure of the Policy Document

This policy document was drafted following the Child Healthcare Review undertaken over 6 weeks in 2010 in which extensive consultation was undertaken with the senior staff from the Ministry of Health, The United Nations Children’s Fund (UNICEF), World Health Organization (WHO), and NGOs. This document overlaps substantially with the Reproductive Health Policy and Strategy 2010 and care was taken to ensure consistency within the two policies and expands on aspects pertaining to child health in this policy.

The following policies and strategies are relevant to child health:

Reproductive Health Policy and Strategy 2010 +

2008 Food and Nutrition Policy +

Breastfeeding Policy +

National Food and Nutrition Policy for Schools 2009 +

The Fiji Plan of Action for Nutrition 2010-2014 +

Expanded Programme on Immunisation Policy 2010 +

Fiji PMTCT HIV Policy +

Rheumatic Heart Disease strategy (under development) +

Child Welfare Decree 2010 +

This document includes two component areas aligned to the priority child health action areas for Fiji. Each area has a policy statement which translates into a number of key strategic actions. A number of key activities are outlined under each strategic area. The two component areas include:

1. Newborn Care: This is also contained within the Safe Motherhood – Maternal and Newborn Care in the Reproductive Health Policy and Strategy 2010

2. Infant and Child Health

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Chapter 2: Policy Statement for Infant and Child Health

2.1 Vision, Mission and Goal

VISION: The achievement of optimum child health for all children in Fiji

MISSION: To provide comprehensive and integrated health services for all children.

GOALS:

Goal 1: To contribute to the reduction of childhood morbidity and mortality by two thirds between 1990 and 2015, thus contributing to the achievements of MDG 4, specifically:To achieve an IMR of 5.5 per 1,000 live births by 2015 +

To achieve an U5MR of 9.3 per 1,000 live births by 2015 +

Goal 2: To contribute to the reduction in under five under-nutrition by three quarters between 1990 and 2015, thus contributing to the achievements of MDG 1, specifically:To reduce undernutrition in under 5 years olds to 50% by 2015 +

2.2 Policy Statement

All infants and children have access to quality curative and preventive paediatric services to protect and safeguard their health, with particular reference to the most common causes of infant and childhood morbidity and mortality including respiratory illness, diarrhoeal disease, and malnutrition.

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2.3 Key Policy Areas on Infant and Child Health

Policy Statements On Infant & Child Health

Protecting the health of infants and children from common illnesses will support their survival, growth and development to full potential. The policy calls for action and allocation of necessary resources to provide comprehensive and integrated services for infant and child health. This will help to reduce neonatal, infant and childhood morbidity and mortality thus contributing towards the achievement of MDG 4.

Activities Under Strategic Area 1: Neonatal Services

1. Assist in the review of the nursing curriculum in newborn care and neonatal resuscitation training.

2. Review current neonatal services in all subdivisional hospitals to harmonise with the CSP.

3. Provide ongoing training for maternal and neonatal care staff in all subdivisional hospitals, including midwife training in foetal monitoring, neonatal resuscitation, and newborn care.

4. Develop/review standard protocols and treatment guidelines for doctors and nurses for the most common neonatal conditions.

POLICY STATEMENT: All infants and children have access to both curative and preventive paediatric services to protect and safeguard their health, with particular reference to the most common causes of infant and childhood morbidity and mortality including respiratory illness, diarrhoeal disease and malnutrition

Strategic Area 1: Development of a well-functional Neonatal Services.

Strategic Area 2: Development of a well–functional Paediatric Service that provides optimal continuity of care and links in-patient with out-patient paediatric care.

Strategic Area 3: Development of a well functional Preventive Paediatric Service to protect neonates, infants and young children from common illnesses through the EPI programme and other preventive health programmes such as HIV-PPTCT and RHD.

Strategic Area 4: Development of a well functional programme on “Integrated Management of Childhood Illnesses (IMCI)” that aims to reduce the incidence and prevalence of the most common causes of childhood illnesses.

Strategic Area 5: Development of an Infant Nutrition/Feeding programme, including the promotion of Breastfeeding to reduce the incidence and prevalence of nutrition-related causes of childhood illnesses and future non communicable diseases

Strategic Area 6: Ongoing development and support for operational research.

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5. Establish an effective referral and follow-up system to facilitate continuity of care.6. Establish a mechanism for on-going Monitoring and Evaluation (M&E) of neonatal

services – including a regular analytical review of neonatal service data for informed decisions and evidence-based programming.

7. Confidential inquiry of all neonatal deaths and stillbirths with refinement of the data collected regarding the stillbirths and neonatal deaths to determine whether preventable factors were evident or whether the neonate was incompatible with life.

Activities Under Strategic Area 2: Clinical Paediatric Services

1. Assist in the review of the nursing curriculum in MCH and child healthcare.2. Develop specialist paediatric nurses including general paediatrics, PICU and NICU. 3. Review of current Paediatric Services in all hospitals, health centres and facilities;

and identify areas for improvement and resources required.4. All nurses undertaking pre-service, midwifery, and public health nursing to be

trained in basic child health (including IMCI, MCH, Paediatric Life Support (PLS), neonatal resuscitation etc) with regular refresher courses.

5. Capacity building and in-service training for clinical staff in all hospitals and clinical settings in the CPGs and other core paediatric skills namely IMCI, PLS, Advanced Paediatric Life Support (APLS), and the WHO Pocket Book for Hospital Care of Children.

6. Provision of a career path for Diploma graduates and revitalisation of the Diploma in District Practice.

7. Review and dissemination of standard protocols and CPGs on the most common Paediatric conditions.

8. Establish an effective referral and follow-up system to enhance continuity of care.9. Establish mechanisms for on-going M&E of Paediatric services – including a regular

analytical review of paediatric service data for informed decisions and evidence-based programming.

10. Confidential inquiry of all under 5 year old deaths.11. Conduct outreach clinics to sub divisional hospitals.12. Review of child disability and early intervention services.13. Review of child and adolescent mental health services.

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Activities Under Strategic Area 3: Preventive Paediatric Service through EPI, HIV-PPTCT, RHD programmes.

1. Specialist input into the revised VHW curriculum.2. Develop teaching aids and health promotion materials for MCH nurses and VHW.3. Revise MCH card/booklet.4. Strengthen partnerships with NGOs and community organisations and offer VHW

training to their community health workers.5. Ongoing support for EPI.6. Implementation and evaluation of the infant pneumococcal conjugate and rotavirus

vaccines, and HPV vaccine into the school health programme.7. Ongoing support for HIV-PPTCT.8. Support for the development of the RHD strategy.9. Ongoing support for the RHD programme for screening and secondary

prophylaxis.10. Review of school health screening and incorporation of RHD screening.11. Finalise child protection policy.

Activities Under Strategic Area 4: Integrated Management Of Childhood Illnesses

1. Review/develop policies and guidelines relating to IMCI and wellbeing.2. Provide ongoing training for health care workers in the delivery of IMCI and

wellbeing.3. Provide access for General Practitioners to ICATT (IMCI) training.4. Strengthen referral and follow-up system to improve IMCI and wellbeing.5. Review of medicines and other commodities required for an effective IMCI

programme. 6. Establishment of mechanisms for on-going practical M&E.

Activities Under Strategic Area 5:Infant Feeding And Nutrition, And Breastfeeding

1. Undertake operational research to understand the enablers and disablers of Breastfeeding.

2. Devise evidence based social marketing of Breastfeeding.3. Review of current Breastfeeding and Infant Feeding/Nutrition policies and

practices.4. Capacity building and in-service training for staff involved in the implementation of

the Breastfeeding and Infant Feeding programme.

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5. Develop community supports for Breastfeeding with engagement of community groups and agencies.

6. Establish an effective referral and follow-up system to enhance continuity of care and integration of services to support Infant Feeding.

7. Establish mechanisms for on-going practical M&E to support delivery of Infant Feeding and Nutrition to assist in strategic planning at all levels. 8. D e v e l o p guidelines for the management of children with specific nutritional needs, e.g. HIV positive children and HIV negative infants (HIV positive mother).

9. Incorporation of micronutrient supplementation as a routine particularly for under 2 year olds, pregnant women, and girls in their final year of school.

10. Ongoing support and integration with The Fiji Plan of Action for Nutrition 2010-2014.

Activities Under Strategic Area 6: Ongoing Development And Support For Operational Research

1. Continue partnerships with institutions, agencies, and strengthen links with NGOs to undertake relevant operational research to evaluate the impact of various child health activities and develop the evidence for ongoing strategic planning.

Cross-Cutting Issues1. Appoint a senior child health officer to co-ordinate and monitor the implementation

of the strategy in harmony with other relevant policies and liaise with the divisions on the inclusion of child health activities in annual plans.

2. Regular meetings of the child health committee to guide direction of the implementation of the strategy and monitor progress.

3. Develop a standardised annual child health progress report to assess MDG and other key performance indicator progress.

4. Further training in PHIS and data analysis at all levels of the health system, so activities are strategic and responsive to the common childhood problems.

5. Resources are secured to facilitate the implementation of the activities under each key strategic area in order to operationalise the policy statement. Resources include adequate staffing, facilities and equipment, supplies and commodities.

6. Specialist nurses should be recognised and renumerated with a minimisation of staff movements once staff are trained in a certain area.

7. Plans for integration of Paediatric services into primary health care facilities as a long-term sustainable approach.

8. Integration and linkages for stronger partnership at all levels of implementation and engaging sector-wide approaches.

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9. Apply the principles of primary health care to engage parent, families and communities in infant and child care.

10. Document lessons learned and best practices as a tool for evidence-based programming.

11. Partner agencies and donor community to engage in more effective coordination at divisional and national level.

Performance Indicators

Input indicatorsInfant and Child Health is integrated with national Reproductive Health policy and +

made widely available. Availability of skilled providers – nurses and doctors to provide the services. +

Availability of VHWs. +

Availability of medicines, equipment, and drugs. +

Process and output indicatorsNumber of hospitals with well-equipped and adequately staffed neonatal units and +

paediatric wards.Number of health facilities with trained staff to provide IMCI services. +

Number of health facilities with trained staff to provide Infant Nutrition and +

Immunisation.Number of health facilities with trained staff to provide PPTCT services. +

Establishment of referral mechanisms for an integrated program providing +

continuity of care.Increase in number of trained service providers. +

Increase in number of health facilities equipped to provide optimal infant and child +

health.

Outcome indicatorsReduction in perinatal mortality rate +

Reduction in neonatal morbidity and mortality rates +

Reduction in infant morbidity and mortality rates +

Reduction in under 5 morbidity and mortality rates +

Reduction in Paediatric admissions – respiratory, diarrhoeal diseases and +

malnutritionIncreased EPI coverage +

Reduction in under 5 undernutrition rate +

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on-

goin

g M

oH, F

NU

, FH

SSP,

UN

ICEF

, W

HO

,

4. D

evel

op/r

evie

w s

tand

ard

prot

ocol

s an

d tr

eatm

ent

guid

elin

es fo

r the

mos

t com

mon

neo

nata

l co

nditi

ons.

Prot

ocol

s de

velo

ped

and

dist

ribut

ed.

2012

-201

3Pa

edia

tric

CSN

5. E

stab

lishm

ent o

f an

effec

tive

refe

rral

and

follo

w-u

p sy

stem

to fa

cilit

ate

cont

inui

ty o

f car

e.Re

ferr

al a

nd fo

llow

up

syst

em d

evel

oped

.20

12 &

on-

goin

g Pa

edia

tric

CSN

6. E

stab

lishm

ent o

f mec

hani

sms

for o

n-go

ing

Mon

itorin

g an

d Ev

alua

tion

(M&

E) o

f neo

nata

l se

rvic

es –

incl

udin

g a

regu

lar a

naly

tical

revi

ew o

f ne

onat

al s

ervi

ce d

ata

for i

nfor

med

dec

isio

ns a

nd

evid

ence

-bas

ed p

rogr

amm

ing.

Stan

dard

isat

ion

of th

e co

llect

ion

of N

ICU

dat

a in

3

divi

sion

al h

ospi

tals

.

Annu

al c

olla

tion

of N

ICU

dat

a.

7. C

onfid

entia

l inq

uiry

of a

ll ne

onat

al d

eath

s an

d st

illbi

rths

.D

evel

op re

view

com

mitt

ee a

nd g

uide

lines

.

50%

of a

ll de

aths

revi

ewed

by

end

of 2

012.

>95%

of a

ll de

aths

revi

ewed

ther

eafte

r.

2012

Paed

iatr

ic C

SN, O

BSTE

TRIC

CS

N

STRA

TEG

IC A

REA

2:

Dev

elop

men

t of a

wel

l–fu

nctio

nal P

aedi

atric

Ser

vice

that

pro

vide

s op

timal

con

tinui

ty o

f car

e an

d lin

ks in

-pat

ient

with

out

-pa

tient

pae

diat

ric c

are.

1. R

evie

w n

ursi

ng c

urric

ulum

in M

CH a

nd c

hild

he

alth

care

.Pr

ovid

e sp

ecia

list i

nput

into

revi

sion

of c

urric

ulum

.20

12FN

U, P

aedi

atric

CSN

, MoH

, O

bste

tric

CSN

, FH

SSP

2. D

evel

op s

peci

alis

t nur

ses

incl

udin

g ge

nera

l pa

edia

tric

s, P

ICU

and

NIC

U.

Dev

elop

pae

diat

ric n

urse

trai

ning

cou

rse.

Supp

ort f

or N

ICU

and

PIC

U P

ACTE

M n

urse

s to

de

velo

p gu

idel

ines

, tra

inin

g &

pro

vide

sup

ervi

sion

.

2012

& o

n-go

ing

2012

-201

3

FNU

, Pae

diat

ric C

SN, M

oH,

FHSS

P,

3. R

evie

w c

urre

nt P

aedi

atric

Ser

vice

s in

all

hosp

itals

, he

alth

cen

tres

and

faci

litie

s; a

nd id

entif

y ar

eas

for

impr

ovem

ent a

nd re

sour

ces

requ

ired.

Reco

mm

enda

tions

impl

emen

ted.

Revi

ew u

nder

take

n an

d co

mpl

eted

.

2013

& o

n-go

ing

Paed

iatr

ic C

SN, M

oH, F

NU

, FH

SSP

23


ACTI

VITI

ESPE

RFO

RMAN

CE IN

DIC

ATO

RSTI

MEL

INE

RESP

ON

SIBI

LITY

4. C

apac

ity b

uild

ing

and

in-s

ervi

ce tr

aini

ng fo

r CPG

s an

d ot

her c

ore

paed

iatr

ic s

kills

: IM

CI, P

LS, A

PLS,

W

HO

Poc

ket B

ook,

and

spe

cial

ist C

PGs.

In-s

ervi

ce tr

aini

ng p

lan

deve

lope

d an

d im

plem

ente

d in

eac

h di

visi

on fo

r: IM

CI, n

eona

tal r

esus

cita

tion,

PLS

, AP

LS, W

HO

Poc

ket B

ook.

2013

& o

n-go

ing

Paed

iatr

ic C

SN, F

HSS

P, M

oH

5. R

evie

w a

nd d

isse

min

atio

n of

sta

ndar

d pr

otoc

ols

and

CPG

s on

the

mos

t com

mon

Pae

diat

ric

cond

ition

s.

IMCI

, WH

O P

ocke

t Boo

k, &

spe

cial

ist C

PG a

vaila

ble

in

all r

elev

ant h

ealth

faci

litie

s.20

12Pa

edia

tric

CSN

, MoH

, FH

SSP

6. E

stab

lishm

ent o

f an

effec

tive

refe

rral

and

follo

w-u

p sy

stem

to e

nhan

ce c

ontin

uity

of c

are.

Refe

rral

& fo

llow

up

syst

em e

stab

lishe

d.20

12 &

on-

goin

g Pa

edia

tric

CSN

7. E

stab

lishm

ent o

f mec

hani

sms

for o

n-go

ing

M&

E of

Pa

edia

tric

ser

vice

s –

incl

udin

g a

regu

lar a

naly

tical

re

view

of p

aedi

atric

ser

vice

dat

a fo

r inf

orm

ed

deci

sion

s an

d ev

iden

ce-b

ased

pro

gram

min

g.

Annu

al n

atio

nal N

ICU

and

chi

ld h

ealth

repo

rt.

2012

& o

n-go

ing

Paed

iatr

ic C

SN

8. C

onfid

entia

l inq

uiry

of a

ll un

der 5

yea

r old

dea

ths.

0% o

f all

deat

hs re

view

ed b

y en

d of

201

2.>9

5% o

f all

deat

hs re

view

ed th

erea

fter.

on-g

oing

Paed

iatr

ic C

SN

9. C

ondu

ct o

utre

ach

clin

ics

to s

ubdi

visi

onal

hos

pita

ls.

9 O

utre

ach

clin

ics

perf

orm

ed p

er y

ear i

n ea

ch

divi

sion

.20

12 &

on-

goin

g Pa

edia

tric

CSN

, MoH

10.R

evie

w o

f chi

ld d

isab

ility

and

ear

ly in

terv

entio

n se

rvic

es.

Revi

ew u

nder

take

n an

d co

mpl

eted

.

Reco

mm

enda

tions

impl

emen

ted.

2013

& o

n-go

ing

Paed

iatr

ic C

SN, M

oH

11.R

evie

w o

f chi

ld a

nd a

dole

scen

t men

tal h

ealth

se

rvic

es.

Revi

ew u

nder

take

n an

d co

mpl

eted

.

Reco

mm

enda

tions

impl

emen

ted.

2013

& o

n-go

ing

Paed

iatr

ic C

SN, S

t Gile

s

STRA

TEG

IC A

REA

3:

Dev

elop

men

t of a

wel

l fun

ctio

nal P

reve

ntiv

e Pa

edia

tric

Ser

vice

to p

rote

ct n

eona

tes,

infa

nts

and

youn

g ch

ildre

n fr

om c

omm

on

illne

sses

thro

ugh

the

EPI p

rogr

amm

e an

d ot

her p

reve

ntiv

e he

alth

pro

gram

mes

suc

h as

HIV

-PPT

CT a

nd R

HD

.1.

Spe

cial

ist i

nput

into

the

revi

sed

VHW

cur

ricul

um.

VHW

cur

ricul

um fi

nalis

ed.

2012

MoH

, Pa

edia

tric

CSN

2. D

evel

opm

ent o

f tea

chin

g ai

ds a

nd h

ealth

pr

omot

ion

for M

CH n

urse

s an

d VH

W.

Mat

eria

ls d

evel

oped

& d

istr

ibut

ed20

12M

OH

, Pae

diat

ric C

SN

3. R

evis

ion

of M

CH c

ard/

book

let.

MCH

car

d/bo

okle

t dev

elop

ed &

dis

trib

uted

.20

12-2

012

Paed

iatr

ic C

SN, M

oH, F

HSS

P

4. S

tren

gthe

n pa

rtne

rshi

ps w

ith N

GO

s an

d co

mm

unity

org

anis

atio

ns a

nd o

ffer V

HW

trai

ning

to

thei

r com

mun

ity h

ealth

wor

kers

.

300

com

mun

ity h

ealth

wor

kers

trai

ned

per y

ear.

2012

& o

n-go

ing

MoH

, FH

SSP,

WH

O, J

ICA

5. O

n-go

ing

supp

ort f

or E

PI.

MR1

cov

erag

e ra

te.

2012

& o

n-go

ing

MoH

, Pae

diat

ric C

SN,

UN

ICEF

, JIC

A, W

HO

, FH

SSP,

24

ACTI

VITI

ESPE

RFO

RMAN

CE IN

DIC

ATO

RSTI

MEL

INE

RESP

ON

SIBI

LITY

6. I

mpl

emen

tatio

n an

d ev

alua

tion

of th

e in

fant

pn

eum

ococ

cal c

onju

gate

and

rota

viru

s va

ccin

es,

and

HPV

vac

cine

into

the

scho

ol h

ealth

pro

gram

me.

Dev

elop

men

t of e

valu

atio

n pl

an p

rior t

o ne

w v

acci

ne

intr

oduc

tion.

Impl

emen

tatio

n of

vac

cine

s in

201

2.Ev

alua

tion

of im

pact

.

2012

& o

n-go

ing

MoH

, Pae

diat

ric C

SN,

Mat

aika

hou

se, F

HSS

P

7. O

n-go

ing

supp

ort f

or H

IV-P

PTCT

.M

TCT

rate

s.20

12 &

on-

goin

gM

oH, P

aedi

atric

CSN

,

8. S

uppo

rt fo

r the

dev

elop

men

t of t

he R

HD

str

ateg

y.RH

D s

trat

egy

com

plet

e.20

12M

oH, P

aedi

atric

CSN

9. O

n-go

ing

supp

ort f

or th

e RH

D p

rogr

amm

e fo

r sc

reen

ing

and

seco

ndar

y pr

ophy

laxi

s.O

ngoi

ng R

HD

pro

gram

me

supp

ort.

2012

& o

n-go

ing

MoH

, Pae

diat

ric C

SN

10.R

evie

w o

f sch

ool h

ealth

scr

eeni

ng a

nd

inco

rpor

atio

n of

RH

D s

cree

ning

. Ev

iden

ce b

ased

sch

ool b

ased

scr

eeni

ng p

rogr

amm

e de

velo

ped.

20

12 &

on-

goin

gM

oH, P

aedi

atric

CSN

11.F

inal

ise

child

pro

tect

ion

polic

y.Po

licy

final

ised

.20

12M

oH, P

aedi

atric

CSN

,

STRA

TEG

IC A

REA

4:

Dev

elop

men

t of a

wel

l fun

ctio

nal p

rogr

amm

e on

IMCI

that

aim

s to

redu

ce th

e in

cide

nce

and

prev

alen

ce o

f the

mos

t com

mon

ca

uses

of c

hild

hood

illn

esse

s.1.

Rev

iew

/dev

elop

pol

icie

s an

d gu

idel

ines

rela

ting

to

IMCI

and

wel

lbei

ng.

IMCI

str

ateg

y de

velo

ped.

20

12-2

013

MoH

, Pae

diat

ric C

SN

2. P

rovi

de o

n-go

ing

trai

ning

for h

ealth

car

e w

orke

rs in

th

e de

liver

y of

IMCI

and

wel

lbei

ng.

In-s

ervi

ce tr

aini

ng p

lan

deve

lope

d fo

r eac

h di

visi

on.

2012

& o

n-go

ing

MoH

, Pae

diat

ric C

SN,

FHSS

P, F

NU

3. P

rovi

de a

cces

s fo

r Gen

eral

Pra

ctiti

oner

s to

ICAT

T (IM

CI) t

rain

ing.

ICAT

T pa

rt o

f con

tinuo

us m

edic

al e

duca

tion

for G

Ps.

2012

& o

n-go

ing

MoH

, Pae

diat

ric C

SN

4. S

tren

gthe

n re

ferr

al a

nd fo

llow

-up

syst

em to

im

prov

e IM

CI a

nd w

ellb

eing

.Re

ferr

al &

follo

w u

p sy

stem

est

ablis

hed.

2012

& o

n-go

ing

Div

isio

nal I

MCI

Com

mit-

tee’

s, M

oH, P

aedi

atric

CSN

5. R

evie

w o

f med

icin

es a

nd o

ther

com

mod

ities

re

quire

d fo

r an

effec

tive

IMCI

pro

gram

me.

All h

ealth

faci

litie

s ha

ve IM

CI m

edic

ines

in s

tock

and

IM

CI e

quip

men

t ava

ilabl

e.20

12D

ivis

iona

l IM

CI C

omm

it-te

e’s,

MoH

, Pae

diat

ric C

SN,

FPBS

6. E

stab

lishm

ent o

f mec

hani

sms

for o

n-go

ing

prac

tical

M

&E.

M

&E

plan

dev

elop

ed.

Each

hea

lth fa

cilit

y ha

s M

&E

perf

orm

ed e

very

6

mon

ths.

2012

-201

320

13 &

on-

goin

g

Div

isio

nal I

MCI

Com

mit-

tee’

s, M

oH, P

aedi

atric

CSN

STRA

TEG

IC A

REA

5:

Dev

elop

men

t of a

n In

fant

Nut

ritio

n/Fe

edin

g pr

ogra

mm

e, in

clud

ing

the

prom

otio

n of

Bre

astfe

edin

g to

redu

ce th

e in

cide

nce

and

prev

alen

ce o

f nut

ritio

n-re

late

d ca

uses

of c

hild

hood

illn

esse

s.1.

Und

erta

ke o

pera

tiona

l res

earc

h to

und

erst

and

the

enab

lers

and

dis

able

rs o

f Bre

astfe

edin

g.Re

sear

ch u

nder

take

n w

ith p

artn

ers.

2013

MoH

, Pae

diat

ric C

SN, F

NU

, U

NIC

EF

25

Child Health Policy and StrategyAC

TIVI

TIES

PERF

ORM

ANCE

IND

ICAT

ORS

TIM

ELIN

ERE

SPO

NSI

BILI

TY2.

Dev

ise

evid

ence

bas

ed s

ocia

l mar

ketin

g of

br

east

feed

ing.

Soci

al re

sear

ch u

nder

take

n an

d m

arke

ting

plan

de

velo

ped.

2012

-201

3M

oH, P

aedi

atric

CSN

, FN

U,

UN

ICEF

, FH

SSP

3. R

evie

w o

f cur

rent

Bre

astfe

edin

g an

d In

fant

Fee

ding

/N

utrit

ion

polic

ies

and

prac

tices

.Re

view

com

plet

ed.

Revi

sed

polic

ies

final

ised

2012

-201

3M

oH, P

aedi

atric

CSN

, FN

U,

UN

ICEF

, FH

SSP

4. C

apac

ity b

uild

ing

and

in-s

ervi

ce tr

aini

ng fo

r sta

ff in

volv

ed in

the

impl

emen

tatio

n of

the

Brea

stfe

edin

g an

d In

fant

Fee

ding

pro

gram

me.

In-s

ervi

ce tr

aini

ng p

lan

deve

lope

d &

impl

emen

ted.

2012

& o

n-go

ing

MoH

, Pae

diat

ric C

SN, F

HSS

P,

UN

ICEF

5. D

evel

op c

omm

unity

sup

port

s fo

r Bre

astfe

edin

g w

ith e

ngag

emen

t of c

omm

unity

gro

ups

and

agen

cies

.

Iden

tify

sust

aina

ble

com

mun

ity s

uppo

rt g

roup

s pa

rtic

ular

ly in

are

as w

here

exc

lusi

ve b

reas

tfeed

ing

<30%

.Es

tabl

ish

supp

ort g

roup

s in

>90

% o

f hea

lth fa

cilit

ies

2012

& o

n-go

ing

2013

MoH

, Pae

diat

ric C

SN, F

NU

, U

NIC

EF, F

HSS

P

6. E

stab

lish

an e

ffect

ive

refe

rral

and

follo

w-u

p sy

stem

to

enh

ance

con

tinui

ty o

f car

e an

d in

tegr

atio

n of

se

rvic

es to

sup

port

Infa

nt F

eedi

ng.

Refe

rral

and

follo

w u

p pl

an d

evel

oped

.20

12M

oH, P

aedi

atric

CSN

7. E

stab

lish

a m

echa

nism

for o

n-go

ing

M&

E to

su

ppor

t del

iver

y of

Infa

nt F

eedi

ng a

nd N

utrit

ion

to

assi

st in

str

ateg

ic p

lann

ing

at a

ll le

vels

.

M&

E pl

an d

evel

oped

.20

12-2

013

MoH

, Pae

diat

ric C

SN

8. D

evel

op g

uide

lines

for t

he m

anag

emen

t of c

hild

ren

with

spe

cific

nut

ritio

nal n

eeds

, e.g

. HIV

pos

itive

ch

ildre

n an

d H

IV n

egat

ive

infa

nts

(HIV

pos

itive

m

othe

r).

Gui

delin

es d

evel

oped

and

dis

trib

uted

.20

12-2

013

MoH

, Pae

diat

ric C

SN

9. I

ncor

pora

tion

of m

icro

nutr

ient

sup

plem

enta

tion

as a

rout

ine

part

icul

arly

for u

nder

2 y

ear o

lds,

pr

egna

nt w

omen

, and

girl

s in

thei

r fina

l yea

r of

scho

ol.

>70%

of u

nder

2 y

ear o

lds

rece

ivin

g su

pple

men

ts

annu

ally

.>9

0% o

f pre

gnan

t wom

en re

ceiv

ing

supp

lem

ents

an

nual

ly.

>80%

of fi

nal y

ear s

choo

l girl

s re

ceiv

ing

supp

lem

ents

an

nual

ly.

Ong

oing

Ong

oing

Ong

oing

MoH

, Pae

diat

ric C

SN

10. O

ngoi

ng s

uppo

rt a

nd in

tegr

atio

n w

ith T

he F

iji P

lan

of A

ctio

n fo

r Nut

ritio

n 20

10-2

014

Mem

bers

hip

of F

PAN

com

mitt

ee.

Ong

oing

M

oH, P

aedi

atric

CSN

11. E

stab

lish

proc

ess

for e

arly

det

ectio

n, re

ferr

al,

trea

tmen

t and

feed

back

for a

ll ch

ildre

n fa

iling

to

thriv

e or

sev

erel

y m

alno

uris

hed

Redu

ctio

n in

hos

pita

lised

cas

es o

f sev

ere

mal

nutr

ition

Redu

ctio

n in

mor

talit

y fr

om s

ever

e m

alnu

triti

on

2012

& o

n-go

ing

MoH

, Pae

diat

ric C

SN,

FHSS

P, U

NIC

EF, F

NU

STRA

TEG

IC A

REA

6: O

n-go

ing

deve

lopm

ent a

nd s

uppo

rt fo

r ope

ratio

nal r

esea

rch.

1. C

ontin

ue to

par

tner

with

inst

itutio

ns, a

genc

ies,

an

d st

reng

then

link

s w

ith th

e N

GO

s to

und

erta

ke

rele

vant

ope

ratio

nal r

esea

rch.

Dev

elop

and

impl

emen

t new

rese

arch

act

iviti

es in

pr

iorit

y ar

eas.

20

12 &

on-

goin

g M

oH, P

aedi

atric

CSN

, FN

U

27


Child Health Policy and Strategy 2012 – 2015

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Transcript of Child Health Policy and Strategy 2012 – 2015